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Re: [IP] New thread - unexplained highs - how do YOU change sets

On 20 Apr 98 at 22:10, Bob Burnett wrote:

> I have *always* changed sets before meals, therefore any bolus was taken
> after I changed my set. I was taught to do this during my pump training. The
> thinking here is that a bolus after your set change helps to clear any
> tissue away from the end of the needle or cannula and helps guarantee good
> insulin flow to the site. You do have the added benefit of not having to
> battle the BG rise from carbs you have already eaten if there are any
> immediate problems with your new set. A simple BG check right before eating
> should let you know if things are o.k. with your new set.

When I changed sets before meals and took the meal bolus from the new 
set my bg shot through the roof.  After repeated attempts and site 
changes I finally started changing the set in the middle of the 

> However, after reading about users who leave the old set in after changing,
> it seems like many of you change your set *after* a mealtime bolus, which
> seems to explain why insulin leaks from the site. It takes time for the
> insulin to be fully absorbed after a bolus.

I was getting leaks even if I changed the set before breakfast, where 
the only insulin in the pool at the old site was from the overnight 
basal rates...  I started leaving the old set in for another two 
hours even on the afternoon changes and it helped keep from spiking a 
high bg after a set change.  I went back to the morning changes and 
bolusing through the old site immediately before disconnecting the 
pump for the move just for convenience.  It's slightly easier to 
change the set at home than in the office.  

I think that when you start a new site it takes a while for the 
tissues to start absorbing the insulin.  The old site is saturated 
and that may be what causes it to "go bad" for some people.  

> Am I confused, am I simply mis reading this, or am I the only one who
> changes *before* mealtime boluses and doesn't need to leave the old set in
> to avoid the high BGs after a set change?

Just another case of every individual being different.  As my doctor 
has told me many times - we develop treatment plans by trial and 
error, but mostly by error.

Randall Winchester

* The views expressed here are mine and do not necessarily *
* reflect the official position of my employer.            *
* There's no guarantee on anything said here...
* If I say I understand something completely the only thing
* we can both be assured of is that I must have completely
* misunderstood something. 
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